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185
with 0.07 in the preceding year. 99 cases—87 from
St. Mary's and 12 from St. John's Sub-district—were
removed to Hospital, 114 cases being treated at home.
In London the rate was 0.19 per 1,000 inhabitants,
the average annual rate during the preceding decennium
having been 0.39.
Diphtheria caused 45 deaths in Paddington, as
compared with 39 in the preceding year; 34 of the
deaths occurred in St. Mary's and 11 in St. John's
Sub-district. The rate was 0.38 per 1,000 inhabitants.
All the houses in which the deaths occurred were
carefully inspected, attention being specially directed
in each case to the condition of the water supply and
to the soundness of the house-drain, as proved either
by the water-test, or by the smoke-test, or by the
peppermint-test. In the large majority of cases defects
of some sort were discovered, and subsequently made
good.
It must not be inferred from these observations
that sewage per se is capable of producing diphtheria.
For its production there are probably two prerequisites,
a specific micro-organism and a suitable
site for its development. Foul air, whether from
cess-pools, drains, or sewers, is recognised as capable
of producing sore throat, and it may be fairly assumed
that such a condition favours the development of the
disease, which primarily and most frequently affects
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